Surgical Technique and Outcomes of Selective Tibial Nerve Transfer Surgery in Foot Drop Patients

This study provides a detailed description of the technique using a tibial-to-peroneal nerve transfer for the treatment of foot drop patients, along with a retrospective outcome analysis.

All consecutive patients undergoing selective motor nerve transfer surgery for severe axonal injury of the common peroneal nerve (CPN) between January 1, 2011, and March 31, 2024, were evaluated. Exclusion criteria included age younger than 16 years, follow-up less than 12 months, unwillingness to participate, or concomitant peripheral nerve conditions (eg, polyneuropathy).

Twenty-one patients met the inclusion criteria. The mean patient age was 40 ± 18 years, with an average trauma-to-surgery interval of 7.6 ± 4.0 months. The mean follow-up was 26.3 ± 12.5 months. Median postoperative tibialis anterior muscle strength was 4.1 (interquartile range 3-4.5) on the Medical Research Council scale, with 17 (77%) patients reaching Medical Research Council scores of 3 or higher and being able to walk without an ankle-foot orthosis. There was a significant benefit in terms of final tibialis anterior muscle strength in patients who received 2 or more fascicles transferred compared with a single fascicle and in those who underwent additional CPN neurolysis.

The selective motor nerve transfer technique described is a reliable reconstructive option for restoring active dorsiflexion in patients with foot drop. Both the number of transferred fascicles and the addition of CPN neurolysis are important factors associated with improved outcomes.